Feasibility and Diagnostic Performance of Functional SYNTAX Score Derived From Dynamic CT Myocardial Perfusion Imaging

部分流量储备 医学 冠状动脉疾病 心肌灌注成像 放射科 狭窄 灌注 内科学 心脏病学 核医学 冠状动脉造影 心肌梗塞
作者
Xu Dai,Lihua Yu,Yarong Yu,Wenli Yang,Ziting Lan,Jiajun Yuan,Wen‐Yi Yang,Jiayin Zhang
出处
期刊:Circulation-cardiovascular Imaging [Lippincott Williams & Wilkins]
卷期号:17 (4) 被引量:1
标识
DOI:10.1161/circimaging.123.016155
摘要

BACKGROUND: Computed tomography (CT) fractional flow reserve (FFR)–derived functional SYNTAX score (FSS CT-FFR ) is a valuable method for guiding treatment strategy in patients with multivessel coronary artery disease. Dynamic CT myocardial perfusion imaging (CT-MPI) demonstrates higher diagnostic accuracy than CT-FFR in identifying hemodynamically significant coronary artery disease. We aimed to evaluate the feasibility of CT-MPI–derived FSS (FSS CT-MPI ) with reference to invasive FSS. METHODS: In this retrospective study, patients with multivessel coronary artery disease who underwent dynamic CT-MPI+ coronary CT angiography and invasive coronary angiography or FFR within 4 weeks were consecutively included. Invasive (FSS invasive ) and noninvasive FSS (FSS CT-MPI and FSS CT-FFR ) were calculated by an online calculator, which assigned points to lesions with hemodynamic significance (defined as FFR invasive ≤0.80, invasive coronary angiography diameter stenosis ≥90%, CT-FFR ≤0.80, and myocardial ischemia on CT-MPI). Weighted κ value and net reclassification index were calculated to determine the consistency and incremental discriminatory power of FSS CT-MPI . Receiver operating characteristic curve analysis was used for the comparison of FSS CT-MPI and FSS CT-FFR in detecting intermediate- to high-risk patients. RESULTS: A total of 119 patients (96 men; 64.6±10.6 years) with 305 obstructive lesions were included. The average FSS CT-MPI , FSS CT-FFR , and FSS invasive were 15.58±13.03, 16.18±13.30, and 13.11±12.22, respectively. The agreement on risk classification based on the FSS CT-MPI tertiles was good (weighted κ, 0.808). With reference to FSS invasive , FSS CT-MPI correctly reclassified 27 (22.7%) patients from the intermediate- to high SYNTAX score group to the low-score group (net reclassification index, 0.30; P <0.001). In patients with severe calcification, FSS CT-MPI had better diagnostic value than FSS CT-FFR in detecting intermediate- to high-risk patients when compared with FSS invasive (area under the curve, 0.976 versus 0.884; P <0.001). CONCLUSIONS: Noninvasive FSS derived from CT-MPI is feasible and has strong concordance with FSS invasive . It allows accurate categorization of FSS in patients with multivessel coronary artery disease, in particular with severe calcification.
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